By using a population-based cohort of the general Dutch population, the authors studied
whether an excessively negative orientation toward pain (pain catastrophizing) and
fear of movement/(re)injury (kinesiophobia) are important in the etiology of chronic
low back pain and associated disability, as clinical studies have suggested. A total
of 1,845 of the 2,338 inhabitants (without severe disease) aged 25-64 years who participated
in a 1998 population-based questionnaire survey on musculoskeletal pain were sent
a second questionnaire after 6 months; 1,571 (85 percent) participated. For subjects
with low back pain at baseline, a high level of pain catastrophizing predicted low
back pain at follow-up (odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.0,
2.8) and chronic low back pain (OR = 1.7, 95% CI: 1.0, 2.3), in particular severe
low back pain (OR = 3.0, 95% CI: 1.7, 5.2) and low back pain with disability (OR =
3.0, 95% CI: 1.7, 5.4). A high level of kinesiophobia showed similar associations.
The significant associations remained after adjustment for pain duration, pain severity,
or disability at baseline. For those without low back pain at baseline, a high level
of pain catastrophizing or kinesiophobia predicted low back pain with disability during
follow-up. These cognitive and emotional factors should be considered when prevention
programs are developed for chronic low back pain and related disability.